Dorset Health Authority s1
HEALTH OF CHILDREN IN CARE
IN POOLE
ANNUAL REPORT
April 2012 –March 2013
SECTION / CONTENT / PAGE1. / Introduction
2. / Numbers of Children Placed in Care in
Bournemouth & Poole
3. /
Destination of LAC Leaving Care
4. / Adoption5. / Initial Health Assessments
6. / Key performance indicators
· Review Health Assessments
· LAC placed out of Borough
· Service Level Agreement (SLA)
· Dental Health
· Immunisations
7. / Supporting Children and Young People with Disabilities
8. / Diet and Obesity
9. /
Reducing Sexually Transmitted Diseases and Teenage Pregnancy
10. / Alcohol and Substance Misuse11. / Referrals
12. / Mental Health/Emotional Well-being
13. / Listening to Young People: Satisfaction Survey
14. / Summary of Key Areas of Development 2012/13
15. / Key Areas for Development During 2013/14
16. / References
CONTENTS
1. introduction
1.1 This annual report for 2012-2013 aims to review the service for the Poole Children in Care Specialist Nurse and set priorities for the coming year. This report is set out in line with the agreed Service Specification for Children & Families Looked After Children & Young People. The aims of the Children in Care Specialist Nurse Service in Poole are:
· To co-ordinate and develop health services for children who are ‘Looked After’ or ‘in care’ across Bournemouth and Poole.
· To have a commitment to improving the health outcomes for all children and young people in care so that they are able to reach their full potential in achieving the 5 outcomes of Every Child Matters; be healthy, stay safe, enjoy and achieve, make a positive contribution, achieve economic wellbeing.
· To ensure the health and wellbeing of children in care is identified as a local priority and that all structures are in place to manage and monitor the delivery of health care for children and young people in care.
· To work in partnership with statutory and voluntary services in co-ordinating additional health services to address identified complex health needs for children in care, whilst supporting access to universal health services where appropriate.
1.2 The team has also continued to adhere to the ‘Promoting the Health of Looked after Children’ guidance (2009) in its approach and ethos in practice.
1.3 The following abbreviations are used throughout the report:
· CiC Children in Care
· CiCHT Children in Care Health Team
· IHA Initial Health Assessment
· RHA Review Health Assessment
· CYPSC Children and Young People’s Social Care
· SW Social Worker
· CAMHS Child & Adolescent Mental Health Service
2. Number of CHILDREN IN Care IN Poole
Table 1 Number of children in care in Poole
Year
/2006/7
/2007/8
/2008/9
/2009/10
/2010/11
/2011/12
/2012/13
Poole
/108
/104
/116
/119
/133
/164
/146
· Following a sharp rise in the number of children in care between 2006 and 2012 the number appears to have now stabilised.
· This is due to a number of factors; consideration re thresholds for children to be brought into care
· High level of support and intervention offered by family support teams
· Increased number of children being placed with extended family
· Rapidity of adoption processes being finalised
Graph 1 No. of Poole Children in Care from April 2012 –March 2103
Although there is some fluctuation in numbers of the overall population of children in care throughout the year the base line number remains relatively stable. This can however ‘hide’ the level of movement within the child in care population.
Graph 2; ‘Ins and Outs’ April 2012-31/3/13
2.1 There has been a total of 70 new admissions to care in the year ending 31/3/13. Graph 2 shows the clear fluctuation in the numbers of admisions and discharges of children in care throughout the year. Of these new admissions,13 left care before the IHA could be completed and a further 17 left care within the first 12 months of their admission. This means a total of 40 children remain in care from this year’s new admissions.
2.2 The majority of the children and young people coming into care over the year have suffered some form of abuse or neglect. There have been a number of older children (aged 12+) who have suffered acute family breakdown or dysfunction. These young people have often been known to social care for a number of years and also have a history of poor childhood experiences often including neglect and domestic violence. They present with complex emotional, social and physicalhealth needs.
Table 2 Breakdownby Age and Gender of Poole Children in Care 31/3/13
2.3 There continues to be a significantly higher proportion of boys to girls in care. It is interesting to note that there are a significant number of children in the 6+ year’s age range, who if unable to return to their birth family are less likely to achieve permanence through adoption. They are therefore likely to spend the rest of their childhood in care. It is vital to engage with this age group to promote key health massages and to support the foster carers in the delivery of health care.
Table 3 Placement Location of Poole Children in Care 31/3/13
2.4 The vast majority of Poole Children in Care are placed within the county of Dorset. Only a small number of the total live outside Dorset which does allow for easier contact and visiting. It also lessens the need to comission nurses from other areas to complete RHAs.
3. Destination of Children and young people Leaving Care
Graph 3 Destination of Poole Children discharged from care
3.1 A total of 74 children and young people have left care over the year. Their ‘destination’ is shown in Graph 2. Whenever a child or young person leaves care the CiCHT liaises with the relevant health professionals to ensure continuity of health care and in some instances to ensure safegaurding concerns are monitored from a health perspective.
3.2 A child’s ‘permanence’ is decided through a clear pathway of decision making (Public Law Outline 2008) . A number of formal, multi-agency meetings take place and the CiCHT are regularly invited to attend and contribute to these decision making forums. This ensures that all health professionals involved in a child’s health care can be kept informed of permanency plans.
4. Adoption
4.1 About 15 children have been placed for adoption over the past year. The CiCHT have ensured that a health assessment is completed prior to the child leaving their foster placement. This ensures that current health information is available to the adoptive family and receiving health professionals.
4.2 Each child being placed for adoption is also issued with a replacement Red Book to ensure continuity of health information and to give the child an accurate health life story.
4.3 The Designated Doctor completed 20 adoption medicals during the year.
5. Initial health assessment (IHA) FOR CiC (new into care)
5.1 A total of 57 IHAs have been completed during the year. These have been co-ordinated by the CiCHT and completed by the Designated Doctor. Each IHA presents its own challenges to arrange but generally the process is working well with the collaboration of the Social workers and foster carers.
5.2 Birth parents have been encouraged and enabled to attend the appointments whenever possible and this provides invaluable information for the assessment.
5.3 The time frame for the completion of the assessment and issuing of the health plan has steadily improved over the year.
· Birth history and immunisation history has been returned reliably from the Child Health Information Department.
· GP printouts have been returned generally within a few days of the request.
· 5School health records and Health Visitor information have been returned reliably.
5.4 All of the above are contributing to a more robust and thorough IHA.
5.5 The Specialist Nurse has attended a number of initial CiC review to present the health plan and to assess whether any immediate health intervention is needed.
5.6 Benefits seen this year since changing thepathway for IHA completion;
· Closer involvement of birth parents
· Access to GP/school nurse and child health information
· Health plan being available at time of child’s first in care review
· Assessment undertaken by Designated Doctor for CiC
· Designated Doctor will sometimes complete the adoption medical at a later date and will have already met the child for their IHA.
6. Key performance indicators
Review Health Assessments (RHA)
Pre-school Children
6.1 Responsibility for completing the RHA for pre-school children has been transferred to the Health Visitors (HVs). Training by the Poole Specialist Nurse has been given to all the HVs in Poole to enable them to understand both the process and also the aims of the assessment.
6.2 To date, 12 RHAs have been completed by 6 different HVs. There are a relatively low number of Poole pre-school children in care (30). A high percentage of this age group are in the ‘adoption arena’ which means that they will have had an adoption medical as part of the process of preparing for the court decision.
6.3 The adoption medical is counted as their RHA which also explains the relatively low number completed by the HVs.
6.4 The CiCHT has liaised closely with the HVs to ensure that they are invited to the CiC reviews and relevant meetings. The Specialist Nurse has attended HV locality meetings and a triangle meeting to liaise with HVs about their new role.
6.5 The HVs have also been active in liaising with the receiving HV when a child is placed for adoption.
6.6 Where it has been advised against the child’s HV meeting the birth family e.g. when a child is placed in a concurrent foster/adoption placement, the Specialist Nurse has attended some contact sessions. This has ensured that birth parents have been kept fully informed about health issues and have been given the opportunity to ask questions about their child’s health / development.
Benefits seen this year since HVs completing the RHA (0-5yrs)
· Continuity of care for children if original HV is involved – this continues through to the child’s permanence i.e. either through liaison with new HV if adopted or through supporting the birth family if the child returns home
· Higher level of satisfaction for the HV to see child through their journey into and out of care
· Raised level of awareness of the specific health needs of CiC
· Increased awareness of the ‘unique journey’ for children who have been adopted and placed in Poole from other areas
School age children and young people (5-18 years)
6.7 The Specialist Nurse has continued to complete the RHA for this age group. This direct involvement with the children is held in high regard by our colleagues in Social care. It also underpins the role of the CiCHT in supporting children and young people to reach their potential in fulfilling the 5 outcomes in the ‘Every Child Matters’ agenda.
Review of RHAs
6.8 Only 2 young people have refused to have direct contact with the Specialist Nurse. However, the CiCHT has been actively involved in supporting the health care of these 2 young people through both their carers and their Social Workers.
6.9 For children and young people in long term foster care the RHAs are now being timed to take place just before their birthday. It is anticipated that this will inform and benefit specific transitions i.e. transfer to Pathways Team (age 16 yrs) or when young people leave care (age 18 yrs).
6.10 The Specialist Nurse has attended the Poole Kids in Care Group (PKiC) to discuss potential changes to the process for the RHA. The group gave positive overall feedback regarding the proposed changes and were able to give specific suggestions as to how the changes could be implemented. These changes are being implemented from April 2013 and will be discussed later in the report.
6.11 Data regarding dental check, immunisation status, BMI, substance use, Strengths and Difficulties questionnaire (SDQ) and sexual health are recorded using a traffic light system which enables the CiCHT to see which children and young people have high level health needs.
· A total of 167 RHAs have been completed during the year. This is equivalent to 95% of expected RHAs.
· Only one out of area RHA has been completed through a Service Level Agreement (SLA). This is because the other young people placed out of area have not been due for reviews during the year.
· The Specialist Nurse did travel to see 2 children placed in the same out of area placement – sharing the journey with the children’s Social Worker who was also visiting. This was a cost effective way of completing the assessments.
· When children who are placed out of area come home for holidays or to visit their family, the Specialist Nurse has seen them during their visit. A dialogue with their carers has also taken place to complete the assessment.
Poole CiC Placed Out of Dorset
6.12 It has been an ongoing challenge to ensure that CiC who have been placed outside Dorset have received the same level of health support as those placed within the county.
6.13 The CiCHT have had an ongoing dialogue with the carers to monitor the children’s health needs. This has been supplemented by a regular sharing of information with the child’s Social Worker and the reviewing officer. In Poole, the Social Workers visit out of county placements every 4 weeks which has helped to monitor their health needs but it has been evident that the level of opportunistic health support is understandably less than for local children.